Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301033302 | MI |
N | 2080P0208X | Pediatric Infectious Diseases | 4301033302 | MI |
NPI | 1386821387 |
---|---|
Provider Name | Dr. Thomas Charles Shope |
First Address | Ann Arbor, MI 48108 |
Second Address | Canton, MI 48187-5097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 11/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F00478 | (02) | MI |